MSK Flashcards by Alex Marsden

Which part of the join becomes infected in septic arthritis?

joint space

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what age does septic arthritis commonly occur?

<2yrs

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how can septic arthritis occur?

usually - haematogenous spread
puncture wound
infected skin lesions
adjacent osteomyelitis

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What are the most common causative organisms of septic arthritis?

staph. aureus

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What are the signs/sx of septic arthritis?

limp/pain referred to knee
red hot tender joint 
reduced ROM
febrile 
pseudo paresis

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What is the criteria used to diagnose septic arthritis?

kosher:
fever >38.5
Non-weight bearing
Raised ESR + WCC

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What is the definitive investigation for septic arthritis?

joint aspiration and culture

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What are other investigations for septic arthritis?

FBC - WCC, ESR/CRP
blood cultures
us of deep joints - joint effusion
XR - normal in SA but will exclude trauma and bony lesions

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What is the management of septic arthritis?

IV flucloxacillin or clindamycin
Joint wash out/ surgical drainage
Keep joint immobilised in functional position at first then mobilise to prevent deformity

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What is juvenile idiopathic arthritis defined as

persistent joint swelling >6 weeks presenting before 16yrs in absence of infection or any other cause

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What are the subtypes and how are they classified?

→      Oligoarthritis = ≤4 
→	Polyarthritis = >4 joints
→	Systemic = incl. fever and rash 
→	Psoriatic 
→	Enthesitis
→	Subtyping further classified according to the presence of rheumatoid factor and HLA B27 tissue type

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What are the symptoms of JIA?

Gelling
morning joint stiffness
pain
fever

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What are signs of JIA in young child

intermittent limp
deterioration in behaviour/mood
avoiding fun activities

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What is the cause of eventual swelling in JIA?

Joint effusion
inflammation
chronic due to proliferation of synovium

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What are the effects of long term uncontrolled JIA?

bone expansion from overgrowth causing
valgus deformity
leg lengthening
discrepancy in digit length

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What indicates sepsis or malignancy as a cause as opposed to JIA?

systemic features

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What is the pharmacological management of JIA?

NSAIDs, analgesics to relieve sx
Joint injections
Methotrexate
systemic corticosteroids
cytokine modulators e.g. TNF alpha blockers

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What is important to monitor when giving methotrexate and why

regular bloods due to abnormal LFTs and bone marrow suppression

What are the complications of JIA?

chronic anterior uveitis (visual impairment)
flexion contractures of joints
Growth failure
Constitutional problems (anaemia, delayed puberty)
osteoporosis
Amyloidosis (rare)

What can be done to reduce risk of osteoporosis inJIA?

Dietary supplements of calcium and fit D
regular weight bearing exercise
minimal oral CS use
bisphosphonates???

Why is growth failure a complication of JIA?

anorexia, chronic disease and systemic CS therapy

What joints are commonly affected in oligoarthritis in JIA?

Knee
ankle
wrist

What is Perthes disease?

avascular necrosis of the capital femoral epiphysis of the femoral head to to interruption of the blood supply
followed by revascularisation and reossification over 18-36m

When does Perthes disease commonly present?

5-10yrs

What gender is perthes more common in and by how much?

boys 5x

What is the presentation of perthes disease? give the nature of onset

insidious LIMP hip/knee pain stiffness, reduced ROM

What can perthes disease be confused w ?

transient synovitis

What are ix for perthes disease, what will they show?

Hip XR early sign: increased density of femoral head then becomes fragmented and irregular

What is the management of early perthes disease

bed rest and traction

What is the management of later perthes disease?

cover femoral head in acetabulum by maintaining hip in abduction joint replacement due to risk of arthritis

What indicates a good prognosis of perthes disease?

younger (increased ability to remodel)

What is SCFE

slipped capital femoral epiphysis

Who is SCFE more common in?

10-15 yrs | obese boys

/What is SCFE associated w

metabolic endocrine abnormalities | e.g. hypothyroidism + hypogonadism

What is the presentation of SCFE

Either: acute or chronic LIMP hip pain (can be referred to knee)

what is found on examination in SCFFE?

restricted abduciton and internal rotation of the hip

How is SCFE diagnosed? what sign is seen?

Hip XR - trethowans sign

What is the management of SCFE?

Surgical pin

What is osteogenesis imperfecta also known as?

brittle bone disease

What is type 1 osteogenesis imperfecta? give the features

the milder and more common form fractures during childhood blue sclerae some have hearing loss

What is type II osteogenesis imperfecta?

severe and lethal multiple fractures before birth many stillborn

What type of inheritance is osteogenesis imperfecta?

autosomal dominant

What is the underlying pathology of osteogenesis imperfecta?

disorder of collagen metabolism leading to bone fragility, bowing and frequent fractrues

What is the treatment of type I osteogenesis imperfecta

bisphosphonates | splinting of fractures to minimise joint deformity